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TRICARE Basics

Joe Wallace

The Basics of TRICARE: An Overview

TRICARE is a health care program offered to military members, veterans, and their families.  TRICARE offers a blend of coverage and treatment opportunities shared between civilian providers and the military healthcare system. TRICARE is offered worldwide, and there are specific coverage options for remote assignments, those who are military retirees, and military family members.

The TRICARE official site reminds applicants that each branch of service determines who in its ranks is eligible for TRICARE. At press time that includes but may not be limited to:

• Active duty service members and families
• National Guard/Reserve members and families
• Retired service members and families
• Beneficiaries eligible for TRICARE and Medicare
• Survivors
• Children
• Former spouses
• Medal of Honor recipients and families
• Dependent parents
• Parents-in-law
• Foreign Force members and families

To see if you are eligible for TRICARE, check your records in DEERS to make sure your information there is fully up to date. Then review your eligibility for TRICARE by logging into MilConnect.

Where You Get Healthcare Under TRICARE

Depending on your location, you may have the option to get on-base care at a military clinic or hospital, you may be able to choose a civilian provider in your network, or you may need to select an authorized-but-non-network option.

If you choose care on-post, know that you will be given priority based on your TRICARE healthcare plan. TRICARE Prime and TRICARE Plus patients have priority on base, so if your plan is on a lower priority you may wish to select a different option. But how do you know which plan you are on?

TRICARE Coverage Plans

There are many options, but what you qualify for from the list below depends on where you are stationed if you are still serving, whether you are a retiree or not, and whether you are on active duty or not. Your TRICARE options include:

• TRICARE Plus
• TRICARE Prime
• TRICARE Prime Remote
• TRICARE Prime Overseas
• TRICARE Prime Remote Overseas
• TRICARE Select
• TRICARE Select Overseas
• TRICARE For Life
• TRICARE Reserve Select
• TRICARE Retired Reserve
• TRICARE Young Adult
• US Family Health Plan

Of the options listed above, active duty troops are automatically enrolled in TRICARE Prime. All others have the choice to use Prime or TRICARE Select which is a preferred provider organization plan also known as a PPO.

TRICARE Prime and TRICARE Select are offered as stateside options and overseas options. When you are assigned to a base overseas after having served stateside, you will enroll in the Overseas version of Prime or Select. That enrollment is not necessarily automatic–expect to file paperwork and update your insurance coverage.

RELATED: TRICARE Prime vs Select: How To Decide

Enrolling In TRICARE Prime When Entering Active Duty

When you ship out to your basic training, the TRICARE official site says you are “automatically covered” by TRICARE Prime but enrollment is still required. New troops typically sign up for TRICARE at their first duty assignment.

You’ll enroll any qualifying immediate family members at that time, but those family members must be registered in DEERS.

Those wondering about dental coverage should know that in most cases active duty members get dental care at an on-base clinic but there are civilian options available via the Active Duty Dental program operated by United Concordia.

Active duty troops should know that TRICARE is the only health benefit you may use. There are no out-of-pocket expenses under TRICARE Prime; those who must pay for coverage are reimbursed by TRICARE.

TRICARE For National Guard/Reserve Members and Families

Members of the Guard/Reserve and their family members may be eligible for TRICARE. You’ll need to log into the Defense Manpower Data Center or MilConnect to verify eligibility for Line of Duty Care, Active and Inactive care, and options for those who are retiring. In general, the TRICARE official site says members of the Individual Ready Reserve (IRR) may have the option to purchase dental coverage but typically do not qualify for other TRICARE benefits unless on active duty orders OR recently deactivated.

TRICARE Enrollment Seasons

Like many insurance programs, once enrolled in Prime or Select you may only make changes to your enrollment during the Open Season or after a Qualifying Life event such as a marriage, leaving active duty, or the birth of a child. Changes must typically be applied for within 90 days of the event. For some TRICARE plans (premium-based plans) you can enroll at any time.

What If I Have Other Health Insurance?

The TRICARE official site states that for those with other coverage in addition to TRICARE (think Medicare or coverage offered by an employer, TRICARE supplements do not qualify as “other health insurance,” and the Prime option may not be the best choice in such cases.

What Does TRICARE Cover?

The TRICARE official site reminds, “TRICARE covers services that are medically necessary,” and typically, that means the service is “appropriate, reasonable, and adequate for your condition. and considered proven.” The TRICARE official site says special rules apply to some services, and some services are excluded.

Changes to Defense Health Agency policy have resulted in a certain subgroup of medical services related to prenatal or preconception medical issues being deemed as important in spite of being technically “not medically necessary” and you may be covered under TRICARE for testing in these areas including but not limited to:

• Spinal muscular atrophy
• Cystic fibrosis
• Fragile X syndrome

Learn more about these services and what is currently covered under TRICARE benefits, or contact a TRICARE regional contractor to discuss such testing and what your options are under your plan.

How Much Does TRICARE Cost?

Each TRICARE plan has its own unique features, and your costs may vary depending on the nature of your plan, how many (if any) dependents you want to list in your plan, where you are assigned (stateside or overseas), and other variables. The TRICARE Compare Cost tool can help you get an idea of what to expect from your own coverage.

TRICARE Coverage for Survivors

Surviving family members may still be covered by TRICARE after the service member dies. This will depend on the military status of the service member at the time of death and the relationship of the survivor to the servicemember (a spouse or child).

In the event of the service member’s death, the survivor is not required to update DEERS but the death must be reported to the TRICARE pharmacy contractor in order to update those specific records.

However, some information may be slow to update in certain military records systems; the TRICARE officials site advises that it may be helpful to inform the Defense Manpower Data Center by:

• Visiting a local ID card office with a copy of the death certificate;
• Faxing a copy of the death certificate to 1-800-336-4416 or;
• Mailing a copy of the death certificate to:

Defense Manpower Data Center Support Office
400 Gigling Road
Seaside, CA 93955-6771

TRICARE When Separating from Military Service

Some want to know if they are still eligible for TRICARE coverage when separating (not retiring) from active duty. TRICARE literature states, “You and your family may qualify for temporary health care coverage when you separate from the service”.

In order to know what you may qualify for, you will need to schedule a physical exam and a “separation history” between 90 and 180 days before your official date of separation. This process is designed to help review your “complete medical history”.

Your family members, age 18 and older, may be able to access their medical information on MilConnect up to six months after you separate, but a DS Logon is required.

There are two programs for temporary TRICARE coverage while you are separating. You may qualify for one of the following:

• Transitional Assistance Management Program
• Continued Health Care Benefit Program

The Transitional Assistance Management Program provides up to 180 days of premium-free health care benefits after regular TRICARE benefits end. These benefits help with your transition to civilian life.

The Continued Health Care Benefit Program (CHCBP) is a premium-based plan offering up to 36 months of temporary healthcare coverage when you lose your current eligibility. It is intended as a “bridge” between TRICARE and a replacement health care plan.

 

RELATED:

• TRICARE: A Comprehensive Guide